The front of your American Express Card has room for up to 20 characters. You can select how you want your name to appear on it by clicking on the drop down box. Your surname must appear on the Card. If you have a long name, you may need to use just an initial and your surname.

Maximum 20 characters

As a responsible credit provider, American Express® is obligated to set approval criteria. In order to qualify for The American Express Airpoints Card, you must make sure that you:

Are aged 18 years of age or over

Have a good credit history*

Earn more than $35,000 p.a.

You are a permanent resident/citizen of New Zealand.

If Self Employed you have been trading for at least 18 months or 12 months if you hold an existing American Express issued Card.

I confirm I meet all the above requirements.

*American Express reserves the right to decline applicants who do not satisfy credit approval and income criteria.

ABOUT YOU

All your information is protected on this secure site

General and contact information

Date of Birth (DD/MM/YYYY)*
Date of birth - box 1 of 3 enter the day you were born on, in the format dd
/
Date of birth - box 2 of 3 enter the month you were born on, in the format mm
/
Date of birth - box 3 of 3 enter the year you were born on, in the format yyyy

Are you an existing Air New Zealand AirpointsTM member?*Yes No

If you are not already an Air New Zealand Airpoints programme member, American Express will instruct Air New Zealand to create a new Airpoints membership for you, and link this to your new The American Express Airpoints Card account once approved. By proceeding with your application you accept the Air New Zealand Airpoints Terms and Conditions. These Terms and Conditions may be amended from time to time. More information is contained in the Declaration.

Enter your Airpoints Number*

Identification and Contact Information

For your security and to meet legal requirements, we need to verify the identity of all Card Members. To assist in this process we require your current Drivers Licence number, home phone number and residential address.Please note: • Your NZ Drivers Licence No will be verified with the NZTA for confirmation of your identity; and • We may use you contact information to contact you regarding your application or to request further information to verify your identity.

NZ Driver's Licence NoLicence number (Field 5a) and Version number (Field 5b)

Please provide the full details of your drivers licence including the details in field 5B.

Marital Status*

Number of Dependants (excluding Spouse)*

Highest Level of Education Achieved*

Phone Details

Please enter either a valid home phone or mobile telephone number

Please ensure you have provided either a valid home phone or mobile telephone number.

Home Phone NumberArea Code/Phone Number

Your home telephone number is required as part of our standard credit checks. Having it will help us to process your application as quickly as possible.

Mobile Phone Number

Your mobile phone number may help us to contact you quickly if we have any questions about your application.

American Express requests your e-mail address to send you changes to your product terms and conditions and other important information about your account.

Email Address*

Your email address may help us contact you quickly if we have any questions about your application.

Accommodation*Do you rent or own? - Own Own Outright
Do you rent or own? - Other Mortgage
Do you rent or own? - Rent Rent
Do you rent or own? - OtherLiving With Parents

How long have you lived at this address? (YY/MM)* /

Our communications with you

Email Communications:

Tick this box if you want American Express to keep you updated via email about your Card benefits, rewards and promotions such as exclusive presales, travel and Bonus Points offers. We will not share your email address with others. For more details on how we will use your information please read our
privacy statement
Yes, I would also like to receive marketing communications to the email address I have provided above. I can change my email preferences at any time by visiting www.americanexpress.co.nzPlease note: If you uncheck this option, you will not receive marketing communications via email.Our Privacy Policy Statement outlines how we handle your personal information.

Yes, I would like to receive my statements online and be notified by email every month when my statement is ready to view online.Please note: The Online Statement will be an exact replica of a paper statement. You can download, save and print the statement and we will keep your recent statements organised and available for you securely online for access at anytime and from anywhere. If you uncheck this box, you will receive your statements in the post to your billing address.

YOUR FINANCES

Financial information

We need information about your finances for our credit checks. All your information is protected on this secure application site.

Do you have another American Express Card*
Do you have any other American Express cards? - Yes
Yes
Do you have any other American Express cards? - No
No

Card Number 1*

Card Number 2

Your Annual salary before tax*(No commas or cents, round to the nearest dollar)

Please enter your personal annual income before tax.

Your other Annual income before tax (including rental & investment income) *(No commas or cents, round to the nearest dollar)

Please tell us about any other income (including rental & investment income). Enter '0' if not applicable.

Partner/spouse's Annual income before tax *We will review your Card application based on your Household income. Providing your Partner/spouse’s Annual income will assist us in our review.(No commas or cents, round to the nearest dollar)

Please enter your partner/spouse's annual income before tax. Enter '0' if not applicable.

You have indicated that this is your total combined income. Please review and confirm this is correct by selecting YES.*Yes

Please indicate the Name and Telephone number of an external source who will confirm your financial details. Eg: Accountant, Financial Advisor or Tax Agent.

Contact/Company name*

Contact Phone*Area Code/Phone Number

EXTRA OPTIONS

Supplementary Card

Would you like a Supplementary Card?*
Do you want to take supplementary cards? - Yes
Yes
Do you want to take supplementary cards? - No
No

For added flexibility, you can order a Supplementary Card for a partner or family member, or friend over 18 years of age. You will be responsible for paying for the charges on the Card. you can view the charges made on the extra Card both online and on your paper statements. The extra Card Member can view their charges online but they will not be able to view your charges or other account activity.

Title*

We need to know your full name for our credit checks

Legal First Name*

Initials

Legal Surname*

How would you like your Supplementary Card Member's name to appear on the Card?*Maximum 20 characters

Date of Birth (DD/MM/YYYY)*
Date of birth - box 1 of 3 enter the day you were born on, in the format dd
/
Date of birth - box 2 of 3 enter the month you were born on, in the format mm
/
Date of birth - box 3 of 3 enter the year you were born on, in the format yyyy

Relationship to Basic Card Applicant*

Is the Supplementary Cardmember's address the same as yours?*
Is the address same? - Yes
Yes
Is the address same? - No
No